Evaluation of sex differences in the relationship between diastolic dysfunction and thromboembolism using propensity score analysis

Background: Female sex is a risk factor for thromboembolism (TE) in atrial fibrillation (AF); however, the underlying mechanisms are unclear. We postulated that left ventricular (LV) diastolic dysfunction (LVDD) could be associated with increased thromboembolic risk in women. Methods: From a retrospective cohort, 158 patients (female : male = 79:79) with nonvalvular AF were propensity score-matched for age, presence of diabetes, hypertension, coronary artery disease, congestive heart failure, embolic history, AF type, and AF duration. Cardiac size and function and central aortic stiffness parameters were evaluated. Diastolic function was classified as normal, indeterminate, and LVDD according to recent guidelines. Surrogate markers for thromboembolism (dense spontaneous echo contrast and thrombus) were evaluated using transesophageal echocardiography. Results: Surrogate markers for TE showed a trend to be more frequent in women than in men (21.5% vs 11.4%, P =.086). LVDD was more prevalent in women than in men (22.8% vs 2.5%, P <.001); however, the prevalence of indeterminate diastolic function was not different between sexes (26.6% vs 20.3%, P =.453). Surrogate markers for TE were detected mostly in women with LVDD. LV diastolic parameters showed a restrictive pattern, and aortic stiffness parameters were worse in women than in men. Women with LVDD had increased aortic stiffness compared to women with indeterminate and normal function, whereas aortic stiffness did not differ among men in all groups. Significant relations between LV diastolic function and aortic stiffness parameters were observed only in women. Conclusion: LVDD due to increased aortic stiffness could be related to a higher thromboembolic risk in women with AF.